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Transcript
OCULAR DEFENSE MECHANISMS Dr. WILLIAM J. BENJAMIN Eye Physiology & Ocular Prosthetics Laboratory University of Alabama at Birmingham School of Optometry Presented at the UAB School of Optometry as Part of MIC 200: MICROBIOLOGY and IMMUNOLOGY O t b 28, October 28 2008 HOW THE EYE PROTECTS ITSELF Ô Ô Ô Ô Ô Ô Ô BONY ORBITS AND BROWS LIDS, CILIA, AND BLINKING AQUEOUS TEAR FLUID CORNEAL DEFENSES DEFENSES OF CONJUNCTIVA & LIMBUS AQUEOUS, VITREOUS, LENS, UVEA, RETINA NORMAL OCULAR BACTERIA & FUNGI ROLE OF EYELIDS Ô CILIA AND COLLECTION OF PARTICLES Ô BARRIER FUNCTION Ô VASCULATURE AND LYMPHATIC SYSTEM Ô FATTY ACIDS, OILS, AND WAXES Ô BLINKING THE BLINK AND BLINKING Ô Ô Ô Ô LID APPOSITION AND SQUEEGEE ACTION ADHERENCE AND THE MUCIN THREAD TEAR ROUTE DURING WAKING HRS. HRS LACRIMAL PATENCY & PUNCTAL PLUGS Ô DAKRYOCYSTITIS & ANGULAR CONJ’ITIS Ô TEAR ROUTE DURING SLEEP Ô LAGOPHTHALMOS & ROLE OF REM’s AQUEOUS TEAR FLUID Ô Ô Ô Ô Ô Ô ROLE OF OILY LAYER LYSOZYME BETA LYSIN LACTOFERRIN IMMUNOGLOBULINS: IgA ROLE OF MUCIN LAYER AQUEOUS TEAR FLUID AQUEOUS TEAR FLUID Ô ROLE OF MUCIN LAYER PHYSIOLOGICAL DEFENSES OF THE CORNEA Ô Ô Ô Ô CORNEAL TEMPERATURE OPEN vs. CLOSED EYE; PATCHING INTERCELLULAR EPITHELIAL JUNCTIONS ADHERENCE TO BASEMENT MEMBRANE PHYSIOLOGICAL DEFENSES OF THE CORNEA Ô MICROVILLI AT EPITHELIAL SURFACE Ô SURFACE RENEWAL EVERY 7 DAYS Ô INFILTRATION FROM TEARS, LIMBUS NORMAL OCULAR FLORA (& FAUNA) Ô Ô Ô Ô Ô NORMAL BACTERIAL FLORA NORMAL FUNGAL FLORA NORMAL VIRUSES (?) NO NORMAL CHLAMYDIA, PROTOZOANS MITES: Demodex folliculorum & brevis Worm-Like mites, 0.1-0.4mm long NORMAL FUNGAL OCULAR FLORA Ô Ô Ô Ô Ô FUNGI FROM ENVIRONMENT, AIR, SOIL Candida albicans Aspergillus fumigatus 83+ DIFFERENT SPECIES IN NORMAL EYES INCONSISTENCY WITHIN INDIVIDUALS Ô LARGE EFFECT OF CLIMATE, OCCUPATION Ô CAN ALSO BE PATHOGENS NORMAL BACTERIAL OCULAR FLORA Ô Ô Ô Ô Ô BACTERIA OF SKIN, RESPIRATORY TRACT Staphylococcus epidermidis: 50-80% Staphylococcus aureus: 20-50% Corynebacterium sp. (Diphtheroids): 20-45% 100+ OTHER SPECIES IN “NORMAL” NORMAL EYES NORMAL BACTERIAL OCULAR FLORA Coag. (–) Staph. Coag. (–) Staph. NORMAL BACTERIAL OCULAR FLORA Ô CONSISTENT WITHIN INDIVIDUALS Ô CONSTANT WITH CLIMATE / GEOGRAPHY Ô SECRETION OF INHIBITORY “BACTERICINS” Coag. (–) Staph. Diphtheroid NORMAL BACTERIAL OCULAR FLORA Ô GRAM (–) “PATHOGEN” CARRIERS: ~ 20% Ocular “Typhoid Maries” Making “Eye Eye Contact” Contact Going “Eyeball to Eyeball” Cross-Contamination by Contact Lenses Goldmann Tonometer Tips Ô PATHOGENS AND CLIMATE / GEOGRAPHY NORMAL BACTERIAL OCULAR FLORA Coag. (–) Staph. Diphtheroid NORMAL BACTERIAL OCULAR FLORA É Staphylococcus aureus Corynebacterium diphtheriae NORMAL BACTERIAL OCULAR FLORA Corynebacterium diphtheriae BACTERIA ON LID MARGINS & CONJUNCTIVA Ô THOSE FOUND ON LESS THAN 5% OF EYES Ô GRAM (+) COCCI Streptococcus sp. Streptococcus pneumoniae Micrococcus sp. sp Ô GRAM ((–)) COCCI Neisseria sp. Moraxella catarrhalis BACTERIA ON LID MARGINS & CONJUNCTIVA Ô THOSE FOUND ON LESS THAN 5% OF EYES Ô GRAM (+) BACILLI Bacillus sp. Ô GRAM (–) ( ) BACILLI Escherichia coli Haemophilus sp. Klebsiella sp. Proteus sp. Pseudo. aeruginosa Serratia marcescens NORMAL BACTERIAL OCULAR FLORA Bacillus cereus NORMAL BACTERIAL OCULAR FLORA Bacillus cereus NORMAL BACTERIAL OCULAR FLORA Bacillus cereus NORMAL BACTERIAL OCULAR FLORA Ñ Micrococcus sp. (yellow colony) BACTERIA ON EYELIDS Ô POST-SURGICAL ENDOPHTHALMITIS DUE TO Normal Bacterial Flora Ô MOST COMMON IS COAGULASE (–) ( ) STAPHYLOCOCCUS Ô INCIDENCE ~ 1 PER 750 SURGERIES Increased 2.5 to 6x for Clear Corneal Cataract Extractions Ô BABY SHAMPOO NOT ANTIBACTERIAL 10:1 dilution Harsh on tender eyelid skin Ô ANTIBACTERIAL SOAPS CONTAIN BAK or EtOH Not good for use around the eye BACTERIA ON EYELIDS Ô EYELID HYGIENE Linalool: Liquid distilled from oils of flowers, spice plants, tea trees. It has a pleasant floral scent and is anti-microbial anti microbial. Effective vs. Pseudomonas distilled BACTERIA ON EYELIDS Ô STERILID AVAILABILITY Over-the-Counter (OTC) In a Kit by Prescription with Minocycline HCl tablets to be taken orally. (Rx) BACTERIA ON EYELIDS Ô EYELID HYGIENE Lid Scrub+ ES: >99% effectiveness vs. S. aureus, E. coli, P. aeruginosa, S. marcescens, and M. catarrhalis. BACTERIA ON EYELIDS Ô EYELID HYGIENE Betadine 5% Ophthalmic Prep Solution: by Alcon Povidone-Iodine Normal surgical scrub is 10% Intended for Irrigation of cornea, conj. Periocular antiseptic Sterile and non-irritating Possible Treatment for EKC PHYSIOLOGICAL DEFENSES OF THE ANTERIOR SEGMENT Ô CONJUNCTIVA AND LIMBUS Vascular Supply & Immune System Lymphatic System Ô AQUEOUS FLUID Blood Aqueous Barrier Break Blood-Aqueous Break-Down Down IgG, IgA, Complement Ô CRYSTALLINE LENS Barrier of Capsule, Anterior Epithelium No Immune or Lymphatic Systems PHYSIOLOGICAL DEFENSES OF THE POSTERIOR SEGMENT Ô VITREOUS GEL / FLUID Not Much Defense Ô UVEA Vascular Supply & Immune System No Lymphatic System Ô RETINA Vascular Supply & Immune System Blood / Retinal Barrier No Lymphatic System EFFECT OF AGING ON OCULAR MICROBIOLOGY Ô Ô Ô Ô Ô Ô Ô LYSOZYME DECREASES CONJ. CRACKS, CREVICES ↑ DRY EYE INCREASES BACTERIAL & FUNGAL CONJ’ITIS BACTERIAL & FUNGAL KERATITIS EYELID WRINKLES, CREVICES ↑ BACTERIAL & FUNGAL BLEPH BLEPH’ITIS ITIS EFFECT OF AGING ON OCULAR MICROBIOLOGY CONJUNCTIVAL CRACKS, CREVICES ↑ Ô EYELID WRINKLES, CREVICES ↑ Ô Bulbar Conjunctiva Palpebral conjunctiva